比较踝关节骨折后踝螺钉不同进钉方向固定疗效

doi:10.13418/j.issn.1001-165x.2021.06.017

PDF(2489 KB)

中国临床解剖学杂志 ›› 2021, Vol. 39 ›› Issue (6) : 716-720. DOI: 10.13418/j.issn.1001-165x.2021.06.017

临床研究

比较踝关节骨折后踝螺钉不同进钉方向固定疗效

胡秀年¹，刘辉²，占鹏¹，陈日江¹，廖元军¹，兰伟斌¹，邱汉民¹，陈东风¹

作者信息 +

Comparison of the effect of ankle screw fixation in different directions after ankle fracture

Hu Xiunian¹, Liu Hui², Zhan Peng¹, Chen Rijiang¹, Liao Yuanjun¹, Lan Weibin¹, Qiu Hanmin¹, Chen Dongfeng¹

Author information +

文章历史 +

摘要

目的比较踝关节骨折后侧入路后踝螺钉不同进钉方向的固定疗效。方法选取漂浮体位下后外侧入路对后踝骨折分别采用不同进钉方向螺钉固定患者48例，男性20例，女性28例，年龄（51.88 ± 7.90）岁，左踝20例，右踝28例，依据Lauge-Hansen踝关节骨折分型：旋后外旋型Ⅳ度36例，旋前外旋型Ⅳ度12例。后踝均采用螺钉固定，前向后固定组22例，后向前固定组26例，对比两组手术时间、骨折愈合时间及并发症情况，末次随访采用AOFAS评分进行临床疗效评价。结果两组病例均获随访，随访时间10~20个月，平均（13.0±3.5）个月，均Ⅰ期愈合，无切口感染、血管神经损伤等并发症，手术时间、骨折愈合时间、AOFAS评分均未见统计学差异，P>0.05。结论后外侧入路固定后踝骨折疗效较好，螺钉不同进钉方向具有相似的临床固定结果，手术医生可凭经验选择合适的方法。

Abstract

Objective To compare the effect of different fixation direction of posterior lateral approach on ankle fracture. Methods Forty-eight patients, including 20 males and 28 females, aged (51.88 ± 7.90) years old, 20 left ankles and 28 right ankles were collected for posterior malleolus fractures fixation by posterior lateral approach in floating position, respectively. According to the classification of Lauge-Hansen fracture of ankle joint, 36 cases had supination-extorsion and 12 had pronation-abduction. All posterior malleolus were fixed with screws, including 22 cases in the forward to backward fixation group and 26 cases in the backward to forward fixation group. The time of incision healing and complications, fracture healing time, the last follow-up were evaluated by AOFAS score and operation time between two groups were compared. Results Patients in the two groups were followed up for 10-20 months, with an average of (13±3.5) months. All patients were healed at stage I, there was no incisional infection, blood vessel and nerve damage. There was no statistical difference in operation time, fracture healing time, AOFAS score (P>0.5). Conclusions The posterior lateral approach for fixation of posterior malleolus fractures has a good effect. Different screw fixation directions have similar clinical results, so surgeons can choose the appropriate method based on their experience.

导出引用

胡秀年, 刘辉, 占鹏, 陈日江, 廖元军, 兰伟斌, 邱汉民, 陈东风. 比较踝关节骨折后踝螺钉不同进钉方向固定疗效[J]. 中国临床解剖学杂志. 2021, 39(6): 716-720 https://doi.org/10.13418/j.issn.1001-165x.2021.06.017

Hu Xiunian, Liu Hui, Zhan Peng, Chen Rijiang, Liao Yuanjun, Lan Weibin, Qiu Hanmin, Chen Dongfeng. Comparison of the effect of ankle screw fixation in different directions after ankle fracture[J]. Chinese Journal of Clinical Anatomy. 2021, 39(6): 716-720 https://doi.org/10.13418/j.issn.1001-165x.2021.06.017

中图分类号： R683.42

参考文献

[1] 李应池, 王晓霞, 张文文. 手术治疗不稳定性踝关节骨折[J]. 临床骨科杂志, 2019, 22(5): 616-619. DOI: 10.3969/j.issn.1008-0287.2019. 05.042.
[2] Ahn J, Kim S, Lee JS, et al. Incidence of peroneal tendinopathy after application of a posterior antiglide plate for repair of supination external rotation lateral malleolar fractures[J]. J Foot Ankle Surg, 2016, 55(1): 90-93. DOI: 10.1053/j.jfas.2015.07.007.
[3] 董伟强, 余斌, 白波. 不同手术方式治疗踝关节韧带复合体损伤的生物力学评价[J]. 中国临床解剖学杂志, 2015, 33(5): 573-576. DOI: 10.13418/j.issn.1001-165x.2015.05.019.
[4] Gupta S, Virk JS, Malhotra A, et al. Fragment-specific fixation of trimalleolar fractures utilizing the posterolateral approach: a preliminary experience[J]. J Orthop Surg (Hong Kong), 2019, 27(2): 1-7. DOI: 10.1177/2309499019842289.
[5] Papachristou G, Efstathopoulos N, Levidiotis C, et al. Early weight bearing after posterior malleolar fractures: an experimental and prospective clinical study[J]. J Foot Ankle Surg, 2003, 42(2): 99-104. DOI: 10.1016/s1067-2516(03)70009-x.
[6] Vrahas M, Fu F, Veenis B. Intraarticular contact stresses with simulated ankle malunions[J]. J Orthop Trauma, 1994, 8(2): 159-166. DOI: 10.1097/00005131-199404000-00014.
[7] Tosun B, Selek O, GokU, et al. Posterior malleolus fractures in trimalleolar ankle fractures: malleolus versus transyndesmal fixation[J]. Indian J Orthop, 2018, 52(3): 309-314. DOI: 10.4103/ortho.IJOrtho_308_16.
[8] Odak S, Ahluwalia R, Unnikrishnan P, et al. Management of posterior malleolar fractures: a systematic review[J]. J Foot Ankle Surg, 2016, 55(1): 140-145. DOI: 10.1053/j.jfas.2015.04.001.
[9] Tejwani NC, Pahk B, Egol KA. Effect of posterior malleolus fracture on outcome after unstable ankle fracture[J]. J Trauma, 2010, 69(3): 666-669. DOI: 10.1097/TA.0b013e3181e4f81e.
[10]Duan XJ, Kadakia AR. Operative treatment of posterior malleolar fractures[J]. Open Orthop J, 2017, 11(Suppl 4, M 14): 732-742. DOI: 10.2174/1874325001711010732.
[11] Kamin K, Notov D, Al-Sadi O, et al. Treatment of ankle fractures : standards, tricks and pitfalls[J]. Unfallchirurg, 2020, 123(1): 43-56. DOI: 10.1007/s00113-019-00753-x.
[12] Mak MF, Stern R, Assal M. Repair of syndesmosis injury in ankle fractures: Current state of the art[J]. EFORT Open Rev, 2018, 3(1): 24-29. DOI: 10.1302/2058-5241.3.170017.